A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy

by | Addiction

https://www.nejm.org/doi/full/10.1056/NEJMoa1808779?query=TOC

Comment; As I’ve been telling my patients right along–the pharmacokinetics of E-Cig’s are a lot more similar to cigarettes than patches or other forms of nicotine replacement. E-Cig’s WITH COACHING are more effective than other forms of replacement!

  • Peter Hajek, Ph.D., 
  • Anna Phillips-Waller, B.Sc., 
  • Dunja Przulj, Ph.D., 
  • Francesca Pesola, Ph.D., 
  • Katie Myers Smith, D.Psych., 
  • Natalie Bisal, M.Sc., 
  • Jinshuo Li, M.Phil., 
  • Steve Parrott, M.Sc., 
  • Peter Sasieni, Ph.D., 
  • Lynne Dawkins, Ph.D., 
  • Louise Ross, 
  • Maciej Goniewicz, Ph.D., Pharm.D., 
  • et al.

Abstract

BACKGROUND

E-cigarettes are commonly used in attempts to stop smoking, but evidence is limited regarding their effectiveness as compared with that of nicotine products approved as smoking-cessation treatments.

METHODS

We randomly assigned adults attending U.K. National Health Service stop-smoking services to either nicotine-replacement products of their choice, including product combinations, provided for up to 3 months, or an e-cigarette starter pack (a second-generation refillable e-cigarette with one bottle of nicotine e-liquid [18 mg per milliliter]), with a recommendation to purchase further e-liquids of the flavor and strength of their choice. Treatment included weekly behavioral support for at least 4 weeks. The primary outcome was sustained abstinence for 1 year, which was validated biochemically at the final visit. Participants who were lost to follow-up or did not provide biochemical validation were considered to not be abstinent. Secondary outcomes included participant-reported treatment usage and respiratory symptoms.

RESULTS

A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3%, vs. 51.2% in the nicotine-replacement group) and nausea more frequently in the nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette group). The e-cigarette group reported greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than did the nicotine-replacement group (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group differences in the incidence of wheezing or shortness of breath.

CONCLUSIONS

E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support. (Funded by the National Institute for Health Research and Cancer Research UK; Current Controlled Trials number, ISRCTN60477608.)

Dr. Raymond Oenbrink
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